In addition to male infertility, having low serum testosterone levels is associated with varicoceles and the need for varicocelectomy, according to new study findings.

To determine national trends in varicocele repair, Akanksha Mehta, MD, of Emory University School of Medicine in Atlanta and colleagues queried the 2009–2015 MarketScan Database of more than 13 million privately insured Americans. Of 21,195 men aged 18 to 45 years diagnosed with varicoceles, 8231 men (38.8%) underwent surgical repair. Despite the advantages of microsurgery, 82% had an open procedure, 10.9% microsurgical (10.9%), and 7.1% laparoscopic.

Men who opted for surgery were significantly more likely to have a diagnosis of male infertility (15.5% vs 7.9%) and complete semen analyses (36.1% vs 12.2%). They were also significantly more likely to be diagnosed with male hypogonadism (3.4% vs 0.9%) and to undergo serum testosterone evaluation (42.5% vs 18.8%).

On multivariable analysis, semen analysis and age 18 to 25 years were associated with nearly 3-fold increased odds of undergoing varicocele repair, Dr Mehta’s team reported in the Asian Journal of Andrology. Hypogonadism and serum testosterone evaluation were associated with approximately 2-fold increased odds. Other significant predictors of varicocele repair included the use of hormone therapies, such as clomiphene citrate, aromatase inhibitors, and gonadotropins, and male infertility diagnosis.

Men with high‑deductible health plans were less likely to undergo varicocele repair than men with comprehensive and network plans, presumably due to the high out-of-pocket costs.

“Although male infertility remains the most important indication for varicocele repair, male hypogonadism is emerging as an independent predictor of varicocelectomy, which may represent a change in the clinical management of varicoceles in the USA,” Dr Mehta and his colleagues concluded.